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Q: My 9-year-old daughter has been having recurrent...

August 28, 2000|By Dr. Allen Douma.

Q: My 9-year-old daughter has been having recurrent urinary tract infections for years. She will have an infection and will be treated with antibiotics sometimes for two courses, then it will go away, but it will come back after four to six months.

This time she already has had three courses of antibiotics in succession. She just finished her antibiotics four days ago and she is beginning to feel the pain in urinating again. She had a urine culture and the last antibiotic given her was from that culture.

A: While it's of little comfort to you and especially your daughter, you should know that childhood lower urinary tract infections are quite common in girls and 10 times more prevalent in girls than boys.

Recurrent UTIs are not as common and require more attention.

The urinary tract consists of the kidneys that filter waste products from the blood, the ureters, which are tubes that send the urine to the bladder for storage, and finally the urethra, a single tube that transports the urine outside the body.

The presence of either burning pain while urinating or blood in the urine suggests irritation somewhere along the urinary tract. This irritation can be due to infection, injury, anatomic deformity or tumors.

Infection is the most common cause of urinary tract irritation and bacteria are one of the most common sources of infection. Infection can also be from viral, fungal or parasitic sources.

A urinary tract infection coming downward from the kidneys happens infrequently and there would likely be other symptoms. Nevertheless, you're wise to have your daughter drink plenty of fluids to flush the urinary tract.

In women and girls, organisms causing bladder infection almost always ascend up the urethra. The organisms can ascend to the bladder following sexual activity, poor personal hygiene or other means of physically introducing the organisms to the urethra. Again, your personal hygiene instructions to your daughter are valuable, especially if she follows them.

Her vagina probably isn't a source of infection unless she has a yeast infection of the vagina, which is not common in young girls. Therefore, excess washing of the vagina is unlikely to help, may cause increased manipulation of the urethra and has the potential for her to develop a negative body image about her vagina.

As long as the infection is bacterial and confined to the lower urinary tract, it can usually be controlled with oral antibiotics. However, every effort should be made to keep the infectious process from entering the kidneys and causing serious long-term damage.

Clearly, her urinary tract is being subjected to a strong source of infection. Persistent or recurring UTI, such as you describe, suggests either a "superinfection" involving multiple or variant organisms or the presence of a complicating factor such as blockage by stones or structural deformities.

I suggest that you take the following steps:

- Re-evaluate and re-educate her about personal hygiene.

- Have a complete urinalysis done, particularly looking for a non-bacterial cause of infection.

- Discuss with your doctor whether there is any evidence of physical injury to the urethra.

- Talk with your doctor about checking her urinary tract for blockage.

Most importantly, make sure your daughter understands what's happening and is able to voice her emotional concerns about it.